401k Plan data: THE MOREY ORGANIZATION DENTAL PLAN plan

THE MOREY ORGANIZATION DENTAL PLAN 401k Plan overview

Plan Name	THE MOREY ORGANIZATION DENTAL PLAN
Plan identification number	507

THE MOREY ORGANIZATION DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

THE MOREY ORGANIZATION, INC. has sponsored the creation of one or more 401k plans.

Company Name: THE MOREY ORGANIZATION, INC.

Employer identification number (EIN): 222130568

NAIC Classification: 713100
NAIC Description: Amusement Parks and Arcades

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE MOREY ORGANIZATION DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
507 2013-03-01 JIM BLAKE
507 2012-03-01 JIM BLAKE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
507	2013-03-01	JIM BLAKE
507	2012-03-01	JIM BLAKE

Plan Statistics for THE MOREY ORGANIZATION DENTAL PLAN

401k plan membership statisitcs for THE MOREY ORGANIZATION DENTAL PLAN

Measure Date Value
2013: THE MOREY ORGANIZATION DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-03-01 133
Total number of active participants reported on line 7a of the Form 5500 2013-03-01 0
Number of retired or separated participants receiving benefits 2013-03-01 0
Number of other retired or separated participants entitled to future benefits 2013-03-01 0
Total of all active and inactive participants 2013-03-01 0
2012: THE MOREY ORGANIZATION DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-03-01 124
Total number of active participants reported on line 7a of the Form 5500 2012-03-01 135
Number of retired or separated participants receiving benefits 2012-03-01 0
Number of other retired or separated participants entitled to future benefits 2012-03-01 0
Total of all active and inactive participants 2012-03-01 135

Measure	Date	Value
2013: THE MOREY ORGANIZATION DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-03-01	133
Total number of active participants reported on line 7a of the Form 5500	2013-03-01	0
Number of retired or separated participants receiving benefits	2013-03-01	0
Number of other retired or separated participants entitled to future benefits	2013-03-01	0
Total of all active and inactive participants	2013-03-01	0
2012: THE MOREY ORGANIZATION DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-03-01	124
Total number of active participants reported on line 7a of the Form 5500	2012-03-01	135
Number of retired or separated participants receiving benefits	2012-03-01	0
Number of other retired or separated participants entitled to future benefits	2012-03-01	0
Total of all active and inactive participants	2012-03-01	135

Form 5500 Responses for THE MOREY ORGANIZATION DENTAL PLAN

2013: THE MOREY ORGANIZATION DENTAL PLAN 2013 form 5500 responses
2013-03-01	Type of plan entity	Single employer plan
2013-03-01	Submission has been amended	No
2013-03-01	This submission is the final filing	Yes
2013-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-03-01	Plan is a collectively bargained plan	No
2013-03-01	Plan funding arrangement – Insurance	Yes
2013-03-01	Plan benefit arrangement – Insurance	Yes
2012: THE MOREY ORGANIZATION DENTAL PLAN 2012 form 5500 responses
2012-03-01	Type of plan entity	Single employer plan
2012-03-01	First time form 5500 has been submitted	Yes
2012-03-01	Submission has been amended	No
2012-03-01	This submission is the final filing	No
2012-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-03-01	Plan is a collectively bargained plan	No
2012-03-01	Plan funding arrangement – Insurance	Yes
2012-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

96331

Policy instance

Insurance contract or identification number	96331
Number of Individuals Covered	131
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $2,353
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $77,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,353
Insurance broker organization code?	3
Insurance broker name	BBIG INC. T/A BRET BALSEY INS.

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

96331

Policy instance

Insurance contract or identification number	96331
Number of Individuals Covered	135
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $2,323
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $78,060
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,139
Insurance broker organization code?	3
Insurance broker name	THE NIA GROUP, LLC

Potentially related plans

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Company Name:	THE MOREY ORGANIZATION, INC.
Employer identification number (EIN):	222130568
NAIC Classification:	713100
NAIC Description:	Amusement Parks and Arcades